The Quality Review Nurse- Home Health performs individual patient case review in order to ensure appropriate documentation to reflect current patient level of care. Provides clinical expertise, problem identification and follow-up monitoring. 

Education:

• BSN preferred.

Licensure/Certification/Registry:

• Licensed to practice professional nursing in Illinois.

Experience:

• Two years clinical experience in an acute care setting and one year home health experience.

Other Knowledge/Skills/Abilities:

• Demonstrates strong assessment skills and clinical expertise.
• Demonstrates ability to use data to support process improvement and positive patient outcomes.
• Exemplifies positive “Behavioral Standards”.
• Demonstrates ability to use personal computer hardware and software

1. Works in collaboration with a multi-disciplinary team, as appropriate to establish a Plan of Care that will provide medically appropriate, high quality, efficient, cost-effective patient care.

2. Participates in quality improvement for MHSvc. Monitors performance indicators, including, but not limited to Case Mix Weight, Strategic Healthcare Program (SHP), HIPPS code calculating, etc. to adjust target areas.

3. Audits medical record for accuracy and completeness, referring to the appropriate clinical staff for correction. Advises clinical supervisor/manager of any potential problems or concerns.

4. Assists in training of field staff and serving as educational resource regarding, Oasis data and overall documentation.

5. Identifies risk factors and clinical inconsistencies within the documentation.

6. Coordinates with the billing department concerning claims submission requirements and timely processing of claims.

7. Assists with retrieval and analysis of data in the clinical review process for evaluation of quality and appropriateness of services.

8. Utilizes and integrates evidence-based practice into Careplans and clinical practice.

9. Keeps current on trends, developments and regulatory issues in area of expertise.

10. Cross trains to provide support to intake and scheduling roles as needed.

11. Performs other related work as required or requested.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job.  Incumbents may be requested to perform tasks other than those specifically presented in this description.